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Three Part Question

In [non-pediatric patients with mild traumatic brain injury and haemorrhage] does a [clinical decision rule or score] exist to predict [radiological deterioration]?

Clinical Scenario

A 66-years-old man is brought to the emergency department following a fall from his height. He has a score of 14 on the Glasgow Coma Scale and suffers from nausea. An initial Ct Scan is done showing a 4 mm subdural hematoma in the left frontal lobe. The emergency doctor decides to keep him in observation. The patient remains stable during the next eight hours but still complains about nausea. The doctor considers discharging the patient but is aware of case-reports about late clinical deteriorations. He wonders if a clinical decision rule exists to help him assessing the risk for his patient.

Search Strategy

Pub Med
Mild traumatic brain injur*[Title/Abstract] OR MTBI[Title/Abstract] AND (Heamorrhage[Title/Abstract] OR Hemorrhage[Title/Abstract]) OR Brain Hemorrhage, Traumatic[MeSH Terms] AND (risk[Title/Abstract] OR outcome[Title/Abstract] OR score[Title/Abstract])

Embase
('traumatic brain injury'/exp OR 'mild traumatic brain injury':ab,ti OR mtbi:ab,ti) AND (heamorrhage:ab,ti OR hemorrhage:ab,ti OR 'brain hemorrhage'/exp) AND (score:ab,ti OR outcome:ab,ti OR risk:ab,ti) AND ([adult]/lim OR [aged]/lim OR [middle aged]/lim OR [very elderly]/lim OR [young adult]/lim)

Search Outcome

911 papers were found of which none were relevant to our question.

Comment(s)

Despite the absence of relevant articles, we found several papers about neurological deterioration predictors: age > 65, Glasgow Coma Scale (GCS) <15, multiple injuries on initial Ct Scan and hemorrhage volume > 10 mm on initial Ct Scan.

Clinical Bottom Line

There is no evidence of existing clinical score to predict radiological deterioration in non-pediatric patients with mild traumatic brain injury and haemorrhage.